Hospital heirarchies

Now is a good time write these observations, before we're so familiar with how hospital heirarchy works that we stop questioning it.

Nurses and allied health: last time I briefly mentioned an incident where I was mistaken for a doctor. That time the nurse came around to take routine blood glucose, and said to another nurse "oh, the doctor is in there, we'll come back later". I probably said they can take the blood first, but they insisted on coming back after I finish (which took maybe another half an hour). It seems that it's normal for nurses to "give way" to doctors, and we often see this during daily rounds. That's okay, I guess nurses are always with their patients, and doctors only have limited time with each patient.

But that doesn't mean doctors should see themselves as more important, or somehow "higher" in comparison. Doctors diagnose and investigate, making much of the decisions in patient care. But nurses are the ones monitoring patients, doing much of the physical work of taking care of patients in the hospital. The physiotherapists help the patients to move about and breath better, which so many of these elderly patients need. Social workers are called in for many patients too - otherwise, how can you responsibly discharge a patient when he can't cope with daily tasks of preparing meals, shopping, showering himself at home? There's many others - pharmicists, speech therapists. I admire the work they do.

Picture of the consultant: Consultants have distinct characteristics. Often male. Perhaps with a moustache and glasses, perhaps balding, middle aged (like they're all our parent's age), tall (height seems to help you have the "look"). With a solemn look and limited facial expressions. In a suit, because as my classmate pointed out, the higher up you are, the less you need to do messy procedures. They walk and talk relatively slowly (vs the junior medical staff that are always in a rush from one side of the hospital to another). During a ward round, the other staff on the team are always careful and respectful around them, and the eyes of the staff are always on them. They are the only doctors who are actually addressed as Dr so and so amongst other doctors. The only time junior doctors introduce themselves not by their first name, but as Dr, is when they are on the phone to non medical staff  (eg. the receptionist at the GP clinic).

The medical student: The radiologist in Singapore made a good point about distinguishing medical students from graduates by the way they walk around in clusters. And it seems as a student the more features you share with these consultants the more pro you look. For example, a graduate student who looks older, with a bit of height, a touch of facial hair seems to commands more respect than the youthful face of an undergraduate.

Oh and there are no white coats in many of our hospitals. So the identifying factor of a doctor or medical student is their lack of uniform (nurses often have uniforms) and the stethescope around their neck (which actually seems to be used more often than I expected).

Isn't it interesting, now we can make a more educated guess of who is who even at a new hospital where we don't know anyone...



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